2016-09-18T16:24:43+05:302016-09-18T16:24:21+05:302016-09-18T16:24:43+05:30Acrobat PDFMaker 11 for Worduuid:cde9227b-75b2-4773-af8f-69b9af87d1ebuuid:0cef7df1-40df-41f1-99c1-d0199bfd143816xmlDietary Approach And Its Relationship With Metabolic Syndrome Components user123459Adobe PDF Library 11.0D:20160908093810
International Journal of PharmTech Research CODEN (USA): IJPRIF, ISSN: 0974-4304, ISSN(Online): 2455-9563 Vol.9, No.8, pp 237-246, 2016
Dietary Approach And Its Relationship With Metabolic Syndrome Components 1Adnan S Bajaber, *2Hala M. Abdelkarem and 1Asmaa M El-Mommten 1King Saud University, Faculty of Food Science & Agriculture, Nutrition Department, Riyadh, Saudi Arabia 2National Research Center, Nutrition Department, Dokki, Giza, Egypt. Abstract : Metabolic syndrome is a constellation of conditions that increases a risk of diabetes and cardiovascular disease. The objective of this study is to investigate the association between dietary behaviour and the prevalence of metabolic syndrome (MS), and/or its components among female teachers living in cities and villages in Al-Ahssa region, Saudi Arabia. Six hundreds of female teachers, aged 30–55 years, were recruited at random from among different primary schools living in cities and villages in the Al-Hassa region, Saudi Arabia. Each participating subject submitted a general questionnaire containing demographic and medical history, as well as a food frequency questionnaire. Anthropometric and systolic and diastolic blood pressure was carried out. The prevalence of MS among the study sample, in accordance with AHA/NHLBI and ESC/ESH criteria, was 28% and 24% respectively, and increased significantly with the increase in age (P<0.05). There was a significant association between the prevalence of MS and obesity, diabetes and high blood pressure (BP) (P≤0.05). It showed that a significant association between soft drinks and the appearance of the remaining indicators of MS. We found that waist circumference (WC) was ranked first (27%), followed by low HDL-C, (21.3%; P≤0.05), high BP (19%), high fasting blood glucose (FG) (18.3%) and high triglycerides (TG) (12%) respectively, in accordance with AHA/NHLBI. By the definition of ESC/ESH, WC was ranked first (22.6%; P≤0.05); high BP was ranked second (17%); after that came high FG (16.6%), low HDL-C (14.6%) and high TG (116%) respectively. In regarding to the prevalence of MS, there is no significance difference of females living in cities and village. This study indicated that the prevalence of MS has increased significantly with the increase in age among the study sample. Healthful dietary patterns were associated with a reduced risk for MS in Saudi women at middle age. Key Words: Metabolic syndrome, lipid profiles, nutrition behavior, serum glucose and middle age.
<_سرد-الفقرات xml:lang="EN-US">Introduction
Metabolic syndrome is becoming highly prevalent in many populations worldwide.hyperglycaemia, hypertension, and dyslipidemia (>TG, > low density lipoprotein (LDL-C), <HDL-C). This syndrome predicts the development of type II diabetes and CVD 1 It is a cluster of metabolic risk factors associated with increased risks of cardiovascular diseases and type II diabetes2,3. The components of MS include abdominal obesity, 4, and all-cause mortality5. There are several working definitions for MS proposed by the World Health Organization, the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATPIII), the European Group for the Study of Insulin Resistance (EGIR), and the International Diabetes Federation (IDF) of Insulin Resistance (EGIR), and the International Diabetes Federation (IDF) of Insulin Resistance (EGIR), and the International Diabetes Federation (IDF) of Insulin Resistance (EGIR), and the International Diabetes Federation (IDF) of Insulin Resistance (EGIR), and the International Diabetes Federation (IDF) of Insulin Resistance (EGIR), and the International Diabetes Federation (IDF) of Insulin Resistance (EGIR), and the International Diabetes Federation (IDF) of Insulin Resistance (EGIR), and the International Diabetes Federation (IDF) of Insulin Resistance (EGIR), and the International Diabetes Federation (IDF) of Insulin Resistance (EGIR), and the International Diabetes Federation (IDF) of Insulin Resistance (EGIR), and the International Diabetes Federation (IDF) of Insulin Resistance (EGIR), and the International Diabetes Federation (IDF) of Insulin Resistance (EGIR), and the International Diabetes Federation (IDF) of Insulin Resistance (EGIR), and the International Diabetes Federation (IDF) of Insulin Resistance (EGIR), and the International Diabetes Federation (IDF) of Insulin Resistance (EGIR), and the International Diabetes Federation (IDF) of Insulin Resistance (EGIR), and the International Diabetes Federation (IDF) of Insulin Resistance (EGIR), and the International Diabetes Federation (IDF) of Insulin Resistance (EGIR), and the International Diabetes Federation (IDF) of Insulin Resistance (EGIR), and the International Diabetes Federation (IDF) . Among Arab populations, epidemiological studies about MS have not been widely conducted, but the available data indicate that there is an increase to a common problem9-14
. Published studies all over the world indicate that the prevalence MS is limited
The prevalence of MS is 39% in the Kingdom of Saudi Arabia(KSA) 15, 37.6% in the United Arab Emirates (UAE)16 and appears to be increasing around the world, probably as a result of increasing obesity rates and sedentary lifestyles17. In regardless to the region, several studies confirm an equally alarming prevalence of MS among Arab population18,19. No study has been carried out on a large-scale to determine the extent of MS in a community based setting including learn, apparently healthy females. Many studies show a clear relationship between diet and risk factor of MS20,21. To prevent or manage MS, it has been suggested that we need to understand lifestyle-accompanying risk factors and then modify them. According to Orchard et al. 22, three year cumulative incidences of MS were significantly reduced in a lifestyle intervention group compared with a placebo group, among people who had impaired glucose tolerance at baseline. MS abnormalities were affected by several lifestyle factors, including high body mass index (BMI), smoking, alcohol consumption, lack of exercise and eating habits. Among dietary patterns, the Mediterranean diet and the Dietary Approaches to Stop Hypertension diet were reported to have a strong impact on MS23-25. Recent dietary studies have increasingly used dietary pattern approaches rather than the traditional focus on individual foods, nutrients or dietary components. Dietary pattern approaches are beneficial as they capture the complex nature of dietary intake and explore its relationship with health outcomes. Till date, many studies have reported associations between dietary patterns and MS Western patterns—characterized by high fat foods—have shown to increase the risks of metabolic abnormalities such as type II diabetes and CVD investigate the association between dietary behaviour and the prevalence of metabolic syndrome (MS), and/or its components among female teachers living in cities and villages in Al-Ahssa region, Saudi Arabia. 26,27,6. Despite some inconsistencies in those findings, it is interesting to note that dietary patterns, rich in whole-grains, legumes, vegetables and fish have favorable effects on metabolic abnormalities. On the other hand, 6,28. In this study, we
<_سرد-الفقرات xml:lang="EN-US">Materials And Methods
<_سرد-الفقرات xml:lang="EN-US">Subjects
A cross-sectional study was conducted in females teacher aged 30–55 years. They were recruited randomly from primary schools in cities and villages in the Al-Hassa region of Saudi Arabia. The sociodemographic characteristics were done, including age, occupation, nationality; smoker habits and physical activity. Medical history and laboratory examination as well as diet information from the food frequency questionnaire were performed. Each participating subject a signed consent forms. Ethical approval was obtained from the Medicine Research Center Ethics Committee of Medicine Collage, King Saud University, Riyadh, Saudi Arabia.
<_سرد-الفقرات xml:lang="EN-US">Anthropometric measurements
Anthropometric measurements were performed after an overnight fast for each participating subject. Body weight (kg) and height (cm) were recorded in light clothes and no shoes. Body mass index (BMI) was calculated (kg/m2(cm) and hip (cm) circumferences were performed midway between the iliac crest and the lower costal margin. Blood pressure was recorded by using a standard mercury sphygmomanometer on the left arm after at least five minutes of rest; the mean value of the two measurements was taken. ).Waist
<_سرد-الفقرات xml:lang="EN-US">Biochemical measurements
After a 12-hour fast, a venous blood sample was taken. Both whole blood and serum were stored in plain polystyrene tubes. Fasting BG, glycolated hemoglobin (HbA1c), TG, total cholesterol, and HDL-C were quantified using routine laboratory analysis (Konelab, Finland). LDL-C was calculated using the Friedwald equation [L = C − H − 0.16T; where H is HDL -C, L is LDL -C, C is total cholesterol, T is TG, and k is 0.20 mg/dl.
<_سرد-الفقرات xml:lang="EN-US">Definition of metabolic syndrome
The definition of MS was formed according to (AHA/NHLBI) and (ESC/ESH) of the National Cholesterol Education Program-Third Adult Treatment Panel (NCEP ATP III). In this regard, three or more of the following criteria must be fulfilled fasting plasma glucose (BG) level ≥ 100 mg/dl [5.6 mmol/l], raised blood pressure (BP): Systolic BP ≥ 130 or diastolic BP ≥85 mm Hg, raised TG level: ≥150 mg/dL (1.7 mmol/L), Reduced HDL-C: <40 mg/dL (1.03 mmol/) in males and <50 mg/dL (1.29 mmol/L) in females and raised waist circumference ≥0.102 cm for men and ≥ 0.88 cm for women. 29: raised
<_سرد-الفقرات xml:lang="EN-US">Statistical analysis
Data was analysed using the Statistical Package for Social Sciences (SPSS) version 11.5 (Chicago, IL, USA), while continuous variables were presented as mean ± standard deviation. Frequencies were presented in percentage (confidence interval), and the MS prevalence was presented as overall prevalence, age-adjusted prevalence, and prevalence according to age.
<_سرد-الفقرات xml:lang="EN-US">Results and Discussion:
The socio-demographics of female teachers are presented in Table (1). The percentage of female Participants living in the cities were the most of the sample (59.3%), followed by those living in villages (40.7%) (Table 1). Among the female participants, those who were obese constituted 17%, 11% of them suffered from high BP, and 6.7%, 3.3% and 0.7% suffered from diabetes, hyperlipidemia and cardiac diseases respectively. With respect to physical activity, it has been observed that a high proportion did not engage in physical activity compared to those who did (65.3% vs. 34.7%). The proportion that engages in daily physical activity was 11%; this percentage was very low compared to the size of the sample being studied. The present results show a significant association between the prevalence of MS and obesity, diabetes, BP and blood lipids (P≤0.05). No significant difference for female participants suffering from cardiac diseases and the prevalence of MS (Table 1). Several epidemiological studies have reported regarding the incidence of obesity, diabetes, high BP, high blood lipids and high prevalence of MS. El-Shahri 29 and Bener et al. 30 found a positive association between prevalence of MS and obesity or BMI. A study of Filip et al. 31 in Poland indicated that there was a significant association between high levels of blood lipids and incidence of the prevalence of MS in females. Also, a study conducted on 1,424 males and females reported that there was a significant association between high prevalence of MS and type-2 diabetes 32. The high prevalence of MS ranging from obesity, diabetes, high BP to high blood lipids, was itself the MS criteria. The possibility of this relationship was the resistance of body tissues to the insulin receptor. Table 1: Demographic changes, clinical charcteristic and physical activities of teacher,s particpatants in villages and cities Al-Ahssa region
Demographic changes
Groups
Number (NO)
Percentages (%)
Age Groups
35-41
200
66.7
42-48
86
28.7
49-55
13
4.7
villages
122
40.7
cities
178
59.3
Educate level
Middle educate
26
8.7
Universities
274
91.3
Clinical characteristic
Diseases
NO
%, P<
Obesity
51
17 P< **
Diabetes
20
6.7 P< **
Hypertensive
33
11 P<**
Hyperlipidimia
4.0
1.4
Cardiac diseases
2.0
0.7
Physical activity
No
%
Physical activity practice
105
35
Type of physical activity
Walk
97
32.3
4.0
1.3
Sports game
12
4.0
Swimming
1.0
0.3
NO of physical activity
Daily
34
11.3
weekly
43
14.3
Monthly
26
8.7
Time of physical activity
1/4 hr
28
9.3
½ hr
54
18
≥ 1 hr
21
7.0
Table 2. The relationship between metabolic syndrome and age, commendations among female teacher’s participant
MS criteria (NO) %
Prevalence of metabolic syndrome
MS according to AHA/NHLBI
MS according to ESC/ESH
(85) 28
(73) 24
Age groups
MS criteria
35-41 age
42-48 age
49-55 age
No
%
NO
%
NO
%
MS according to AHA/NHLBI
42
21
36
42
7
50
MS according to ESC/ESH
38
19
29
34
6
43
MS criteria
commendation place
Villages
Cities
No
%
No
%
Prevalence of MS according to AHA/NHLBI
34
28
51
29
Prevalence of MS according to ESC/ESH
35
27
40
22
Study sample: 300 samples Table (2) displays the distribution of MS. It showed that the prevalence of MS among the study sample—in accordance with AHA/NHLBI and ESC/ESH definitions—was 28% and 24% respectively. This prevalence of MS among participating females was more or less with the previous studies conducted in Saudi Arabia. Al-Zahrani et al 33Al-Nozha et al. reported that the prevalence of metabolic syndrome was 21% among healthy adults (35-50 years) in the western region of Saudi Arabia. 34 found that the prevalence of MS among females (30–70 years) was 42%. Al-Daghri et al. 35 found that the prevalence of the syndrome among females (18–80 years) was 34.1%. Our(18–80 years) was 34.1%. Our(18–80 years) was 34.1%. OurTable 3. The prevalence of metabolic syndrome among participant’s teacher for villages and cities in Al-Ahssa region as definition of (AHA/ NHLBI) and (ESC/ ESH)
Classification of metabolic syndrome
Metabolic syndrome indicators
WC
TG
HDL-C
BP
FG
NO
%
NO
%
NO
%
NO
%
NO
%
Infected as (AHA/ NHLBI)
81
27*
36
12*
64
21.3*
58
19.3*
55
18.3*
Infected as (ESC/ ESH)
68
22.6*
35
11.6*
44
14.6*
51
17*
50
16.6*
MS indicators (AHA/ NHLBI) and (ESC/ ESH).
Cities
57.8
57.8
24
13.4
94
52.8
63
35.4
50
23
Villages
64
52.5
26
21.3*
54
443
32
26.2
41
33.6
P ≤ 0.05 Table 4. The relationship between prevalence, metabolic syndrome indicators among participant’s teacher as definition by (AHA/ NHLBI &ESC/ ESH) for villages and cities in Al-Ahssa region.
Metabolic syndrome Classification
Dietary habits
Very Bad
Bad
Good
Very Good
Total
P ≤
Metabolic syndrome as defined (AHA/ NHLBI)
7
28
41
9
85
N.S.
Metabolic syndrome as defined (ESC/ ESH)
6
24
36
7
73
N.S.
Metabolic syndrome Indicators defined as (AHA/ NHLBI)
Dietary habits
Very Bad
Bad
Good
Very Good
Total
P ≤
WC
9
68
76
14
167
N.S.
TG
3
14
26
7
50
N.S.
HDL-C
9
58
68
13
148
N.S.
BP
8
38
41
8
95
N.S.
FG
4
40
38
9
91
N.S.
Metabolic syndrome Indicators defined as (ESC/ ESH)
Dietary habits
Very Bad
Very Bad
Very Bad
Very Bad
Very Bad
Very Bad
WC
9
68
76
14
167
N.S.
TG
3
14
26
6
49
N.S.
HDL-C
17
37
43
4
101
N.S.
BP
8
38
41
8
95
N.S.
FG
4
40
38
9
91
N.S.
Table 5.The effect of food intake on the metabolic syndrome prevalent defined as (AHA/ NHLBI &ESC/ ESH among participant’s teacher for villages and cities in Al-Ahssa region
Metabolic syndrome
defined as (AHA/ NHLBI)
defined as (ESC/ ESH)
Dietary patterns
Injury
Non-injury
Injury
Non-injury
Red Meat
79
193
67
205
Chickens
84
203
71
216
Fishes
79
199
68
210
Crustaceans
60
142
49
144
Cool Meats
18
45
17
43
Livers
70
185
59
193
Tuna
38
99
32
105
Eggs
80
202
67
215
Legumes
82
207
70
219
High fat of dairy milk
83
209
71
221
Low fat of dairy milk
47
113
38
122
White dread & CHO
84
214
71
227
Grain dread & CHO
55
132
47
140
Local foods
83
211
71
223
Fruits &Vegetables
84
213
71
226
Dates
78
190
116
202
Fast food
82
208
70
220
Sugars
83
215*
71
227
Sweets
79
202
64
208
Soft Drinks
50
144*
43
151*
Tea
83
207
71
212
Cap-techno
83
203
70
116
Nuts
80
200
68
112
Margarines
56
167
48
175
The highest prevalence of MS criteria in the study sample was presented in Table (5) in accordance with the definition of AHA/NHLBI & ESC/ESH (Table 4); we found that WC, according to the definition of AHA/NHLBI, was first ranked (27%) with respect to the prevalence of MS criteria, followed by low HDL-C (21.3%; P≤ 0.05), high BP (19%), high FG (18.3%), high TG (12%) respectively. On the other hand, as defined by ESC/ESH, WC was first ranked (22.6%; P≤ 0.05), followed by high BP (17%), FG (16.6%), low HDL-C (14.6%) and high TG (116%) respectively. Some studies suggested that obesity, followed by low HDL-C, were the highest criteria of MS prevalent among males and females 36,37. A cross-sectional study of 4,039 subjects, suffering from hypertension in both sexes, WC was the most prevalent of the components among those participants 42. Several epidemiological studies have reported that the low HDL-C was the first ranked among components of MS. In another cross-sectional study on 530 Saudis with type II diabetes in villages, the low HDL-C was the greatest indicator of MS that was prevalent 43. Otherwise, some studies showed different results, WC 35 and HDL-C 44 were the lowest indicators of MS prevalent among Saudis. With respect to general education, the MS indicators among participants' females in the present study, according to the definition of AHA/NHLBI, indicated that the TG was significantly higher among teachers in villages than cities (Table 5). In a cross-sectional study of people in villages and cities, there was a significant difference in hypertriglyceridemia (P≤0.05), whereas no significant differences in diabetes and hypertension prevalence were seen between villages and cities45. Table 6. The effect of food intakes on the prevalence of metabolic syndrome Indicators as (AHA /NHLBI &ESC/ ESH) among participant’s teacher for villages and cities in Al-Ahssa region
Dietary patterns
WC
TG
HDL-C
BP
FG
Red Meat
151
46
129
86
84
Chickens
163
49
141
90
89
Fishes
156
48
133
91
86
Crustaceans
144
35
96
72
68
Cool Meats
35
5
32
15
26
Livers
145
41
122
73
76
Tuna
80
24
65
41
39
Eggs
159
46
139
89
83
Legumes
162
48
139
93
90
High fat of dairy milk
164
41
148
94
90
Low fat of dairy milk
91
29
80
45
50
White dread & CHO
165
48
147
96
90
Grain dread & CHO
104
34
97
55
56
Local foods
164
50
143
93
91
Fruits &Vegetables
165
50
145
95
90
Dates
151
47
127
86
86
Fast food
162
48
141
43
89
Sugars
165
49
145
95
90
Sweets
157
43
138*
93
85
Soft Drinks
30
11
27
17
15
Tea
108
29
90
58
55
Cap-techno
162
45
141
94
86
Nuts
156
46
135
91
87
Margarines
118
35
105
73
62
Oil- Mayonnaise
142
43
130
84
82
Olive Oil
140
42
125
82
76
In the present results, there was a significant association between soft drinks and the appearance of the remaining indicators of MS, as defined by AHA/NHLBI and ESC/ESH, whereas there was no significant difference between the appearance of the syndrome and the remaining foods (Tables 7,8). Our results were similar to several previous studies that reported a significant increase (48%) in the prevalence of MS in persons who consume soft drinks of one pack or more per day, compared to persons who consume less than one pack on a daily basis 46. In addition, the frequent consumption of drinks and sugars were significantly associated with the increase in the MS components 7. In a cross-sectional study, soft drink consumption has a significant association (P≤0.001) with females having MS 47. In another cross-sectional study, the traditional style of dietary patterns, characterized by low soda intake, had a significant association with high serum HDL-C and low waist circumference (P≤0.05) 48. In this study, the underlying mechanism of the effect of soft drink consumption on MS is not clear, and more research is needed to confirm this effect. The current study revealed a significant association between intake of sweets and low HDL-C (P≤0.05) among the individual samples. No relationship was found with the rest of foods that have been studied (Table 10). In addition, no relationship was found between food intake and place of residence among females participants with metabolic syndrome (data not shown). There were directions in this study, not only with respect to the intake of sugars and sweets on the effect of HDL-C level, but also more than one direction. Metabolic syndrome is a heterogeneous outcome; thus, no single pathogenesis has been elucidated. Various factors, including physiological differences and genetic factors, may affect the underlying contribution of diet to MS 49-50. A greater incidence of diabetes increases significantly in women who consume high percentage of carbohydrates (P≤0.05;>70% of energy) and significantly decreases the HDL-C level 51. Additionally, the Western dietary style, characterized by frequent sweets and soft drinks, was inversely associated with HDL-C (P≤0.05) 52. In another cross-sectional study, the triglycerides level showed a significant increase among the study sample, which characterized the dietary style by the high intake of sweets (P≤0.05) 48.Considering to the prevalence of MS increases with age, the age and health status of the female participants might affect the association. In the present study, 45% of persons were found who follow healthful (good) dietary habits (high fruits, vegetables, cereals and their products, and low animal fat), whereas 6% of them who followed non-healthful (bad) dietary habits (high fast foods, soft drinks, sweets and sugars). No significant association was observed between MS prevalence and dietary habits or between types of MS components and dietary habits (Tables 9,10). In the absence of the significance, we cannot draw conclusions about the incidence of the syndrome and dietary habits. Limitations This study has some limitations, the sample was not large enough to determine ethnic patterns of metabolic syndrome. Additionally, a small population studied, due to the ethnic and cultural heterogeneity of the population of this region. Conclusion This study indicated that the prevalence of MS was 28% and 24%, in accordance with AHA/NHLBI / ESC/ESH criteria and there was no statistical difference between female participants living in cities and village, The dietary pattern that is characterized by high consumption of vegetables, fruits, legumes, lean meat, fish, cereals and low animal fat was associated with a reduced risk for MS in Saudi women in middle age. References
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